Development and Implementation of an Inpatient Smoking Cessation Counseling Pathway for Stroke Patients: A Quality Improvement Study
Objective:
We aimed to evaluate and improve the consistency of our smoking cessation counselling (SCC) on our stroke unit and assess its efficacy.
Background:
Smoking is a major modifiable risk factor for recurrent stroke, yet inpatient SCC is inconsistently delivered. We designed, implemented, and evaluated a standardized inpatient SCC pathway on a tertiary stroke unit.
Design/Methods:
We conducted a three-phase, pre–post quality improvement (QI) initiative: Phase 1-quantify the current SCC gap; Phase 2-develop a consensus pathway using the 5A model (Ask, Advise, Assess, Assist, Arrange), using electronic medical record tools, and guided by modified Delphi consensus among multidisciplinary stakeholders on our stroke service; and Phase 3-Evaluate counseling delivery and short-term smoking outcomes via chart review and 90-day telephone surveys. Adults with ischemic stroke/transient ischemic attack (TIA) who smoked at admission were eligible. Primary outcome measure was the delivery of SCC during hospital admission for stroke. Secondary outcome measures included reduction in cigarettes/day and self-reported cessation at telephone follow up.
Results:
Phase 1 care gap quantification showed 28% (n=14/50) SCC delivery 2022. Phase 3 post-implementation of our pathway, SCC delivery increased to 81% (51/63, p<.001). There was no difference in mean reduction in cigarettes/day between counseled vs non-counseled patients (10.6 vs 9.6, p=.741) nor smoking cessation rates (p=.951).
Conclusions:
A consensus-built, SCC pathway markedly increased counseling delivery but did not improve short-term cessation patient outcomes or process measures. Future iterations could bundle bedside pharmacotherapy, automated referrals, and translate process gains into patient-level benefit.
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